Bowens disease epidermoid carcinoma

Bowen's disease is a term for intra-epithelial squamous carcinoma (Figures 5.30-5.32). It is not as rare as might be inferred from the medical literature.

Figure 5.31

Epidermoid carcinoma—subungual involvement.

Figure 5.31

Epidermoid carcinoma—subungual involvement.

Figure 5.32

(a) Epidermal carcinoma; (b) epidermal carcinoma, with nail plate trimmed back to show extension of invasion. (Courtesy of G. Cannata, Italy.)

Figure 5.32

(a) Epidermal carcinoma; (b) epidermal carcinoma, with nail plate trimmed back to show extension of invasion. (Courtesy of G. Cannata, Italy.)

The clinical picture of Bowen's disease of the nail unit is variable. It may show a periungual erythematous, squamous or eroded plaque. In the lateral nail wall and groove, it usually presents as a recalcitrant hyperkeratotic or papillomatous, slowly enlarging lesion. Distal involvement of the proximal nail fold results in the formation of a characteristic whitish band. The fingers are far more frequently affected than the toes: typically the thumbs, less often the index and middle fingers. The median age at presentation is approximately 60 years, men predominating. Bowen's disease evolves and expands only slowly. Biopsies taken from the most indurated and warty area often reveal invasive squamous cell carcinoma in contrast to the flat plaque. Many authorities therefore no longer differentiate Bowen's disease from squamous cell carcinoma, preferring the term 'epidermoid carcinoma' for all cases.

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